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Insurance Marketplaces, Quality of Care Are Priorities for HHS OIG, Official Says

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By James Swann

Feb. 3 — The Department of Health and Human Services Office of Inspector General will be reviewing the operation of the health insurance marketplaces throughout 2015, especially payment accuracy and enrollment and eligibility, Christi Grimm, the OIG chief of staff told Bloomberg BNA during an interview Jan. 23.

Grimm said the OIG will also be looking at the management of the marketplaces to determine if “practices are in place to allow programs to be run efficiently and effectively,” and at the security of the marketplaces, including whether patient information is private and secure.

She also said that quality will be a major focus for the OIG in 2015, as providers transition from a volume-based payment system to a value-based system. “You'll see some work looking at access to care, the quality of that care and things related to patient safety,” Grimm said.

Health insurance marketplace and quality-of-care reviews were included in the OIG's work plan for fiscal year 2015, which was released Oct. 31, 2014.

Grimm said the OIG develops the work plan based on risk assessment results, such as the number of beneficiaries impacted by a particular program and the dollars that are at risk. She said work plan reviews are also developed based on input received from officials running the individual programs.

Additional Reviews

Other areas of attention for the OIG in fiscal 2015 include the Affordable Care Act's expansion of the Medicaid program, Grimm said.

She said the OIG would be looking at the accuracy of Medicaid eligibility determinations, whether states are accurately calculating their federal match dollars and the rise of Medicaid managed care.

Grimm said Title Six of the ACA, Transparency and Program Integrity, included numerous program integrity provisions affecting the Medicaid program, such as requiring Medicaid provider screening, and she said the OIG would be taking a look at how they're working.

As for Medicare Part A and Part B, Grimm said the OIG would take a look at compliance issues, including whether home health agencies are complying with Medicare requirements. Grimm also said the OIG would be continuing to conduct hospital compliance reviews, and would also be reviewing competitive bidding as well as oversight of Medicare contractors.

Budgetary Issues

While acknowledging that the OIG has been in a hiring freeze since 2012, Grimm said that the administration's FY 2015 budget did give the OIG some additional funding, and she said the agency was very excited “to apply that funding in meaningful ways.”

She said the additional funding would allow the OIG “to patch some holes that have come about through sequestration.”

Grimm said the OIG had close to 1,800 employees in 2012, and is now down below 1,600 employees.

The FY 2016 budget, which was released Feb. 2, includes a request for $417 million, an increase of $80 million from FY 2015's $337 million see related article in the Leading the News section.

To contact the reporter on this story: James Swann in Washington at jswann1@bna.com

To contact the editor responsible for this story: Ward Pimley at wpimley@bna.com

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